Temporomandibular Joint Disorder (TMD) & TMJ Treatment In Pueblo, CO
Temporomandibular joint disorder, also known as TMJ, TMD, or TMJD, is a general term covering any disorder causing inflammation of the temporomandibular joint, which connects the skull to the mandible. There are a number of conditions that can cause pain in the jaw joint and the muscles involved in the closing and opening of the jaw. Disorders affecting the temporomandibular joint can affect a person's ability to eat, speak, swallow, chew, and breathe. The set of TMJ disorders are commonly divided into three general categories, though multiple conditions may be present at once:
- Inflammatory joint disease: Arthritis is a disease that causes inflammation of the joints. A number of forms of arthritis including rheumatoid arthritis, osteoarthritis, traumatic arthritis and infectious arthritis may have an effect on the jaw joint. Synovitis is another condition that can bring about TMJ pain where the synovial membrane that lines the joint and lubricates it becomes inflamed.
- Myofascial pain: The jaw joint and muscles around it can be affected by myofascial pain. This is a disorder where trigger points and muscle tension, commonly in the neck, back and shoulder areas, cause pain in a localized area and referred pain from another region of the body.
- Internal derangement of the temporomandibular joint: Between the mandible and the skull is a disc that acts as a cushion. Displacement or deterioration of the disc can cause pain and inflammation of the joint.
A person suffering from TMD may experience:
- Clicking or popping noise in the jaw
- Being unable to open the mouth comfortably
- Locking of the jaw when trying to open the mouth
- Neck pain, shoulder pain, or upper back pain
- A sensation of an irregular bite
- Swelling of the face around the jaw joint
- Earaches
- Ringing in the ears or decreased hearing
- Dizziness and vision problems
- Pain behind the eye (s)
- Headaches
- Sleep disturbance - including Obstructive Sleep Apnea
- Bruxing or clenching of the teeth( grinding of the teeth) during the day or night
- A sore jaw and/or face muscles upon awakening
TMJ disorders are still relatively unexamined area of medicine, and as such, diagnosis and treatment of these conditions can be difficult. There is no standard accepted test for diagnosing TMJD and both the American Dental Association and the American Medical Association have not established the TMJ area as a specialty due to insufficient scientific research. Still, what is known about TMJD has been used to effectively treat or manage the symptoms of the condition, and ongoing research continues to evolve treatments and broader understanding of the causes and risk factors for TMJD. Occasional discomfort or pain of the jaw joint or facial muscles is not uncommon and can occur for any number of reasons. Often TMJ pain goes away within days or weeks, but if the problem persists for a month or more, a doctor should be consulted.
About TMJ Disorders
The pain and discomfort associated with TMJ, which is identified as a Temporomandibular Joint disorder (TMD), can vary from mild and infrequent to severe and debilitating.
Causes and Treatment
Depending on the level of pain and associated disability, treatment of TMJ may differ. It can also be addressed through different treatment options based on suspected causes. The important part is to determine what is causing the pain. This is based on getting a good diagnosis, which is what Dr. Villalon does at his private practice in Pueblo. Muscles can be the cause of pain, osteoarthritis can be the cause of pain, or it can be caused by other issues such as the ear or some of the facial nerves.
If TMJD symptoms don't hamper daily activities and the pain can be described as between one and three on a ten-point pain scale, the condition is often manageable through patient self-care. This includes performing any of the following basic treatment activities:
-Apply cold and hot packs: An ice pack or cold compress applied to the affected area for 10 to 15 minutes will reduce swelling and inflammation. Moist heat applied to the area between 10 to 15 minutes can also improve circulation to the area and reduce pain.
-Do facial stretching and exercises: Dr. Villalon may recommend stretches at his office in Pueblo that can help reduce tension in the jaw. Perform prescribed exercises as directed to stretch the muscles of the jaw and relieve unnecessary muscle tension.
-Hinge-Axis exercise: The image to the right is what we call the "hinge axis" exercise. The teeth should not touch and you don't want to open very wide, and the motion will look like you have a jaw tremor. You should do this exercise 6 times a day for 30 seconds each time. The goal of this exercise is to stimulate the production of fluid inside the TM joint.
-Eat soft, small foods: Foods that don't require much chewing due to small size or soft texture, such as soup, scrambled eggs, cottage cheese, yogurt, cooked beans, diced fruits, and cooked vegetables will be easier to eat than foods that are hard, crunchy, chewy, thick or large. Salad is an example of a food that requires a lot of chewing, and should be avoided with a painful joint. Here is a page with more information about foods to avoid. The bottom line is that if you are eating a food that causes pain, stop eating that food.
-Take medicine for pain management: Over-the-counter pain relievers such as naproxen (Aleve) can minimize the experience of pain and reduce inflammation. Dr. Villalon may also prescribe stronger pain medications for pain relief. Prescription muscle relaxants may aid patients who grind their teeth by relaxing the muscles of the jaw. Low doses of antidepressants have also been found to reduce pain.
-Avoid high-tension jaw movement: Moving the jaw with excessive force can strain the joint and the muscles that open and close the mouth, and hamper treatments aimed at reducing the pain. Yawning and chewing should be kept to a minimum. Singing or yelling should also be avoided. Proper posture while on the phone or at a computer should be maintained. Avoid clenching the jaw. Practice keeping teeth apart by gently placing the tongue on the roof of your mouth behind your upper front teeth with your teeth slightly separated. Practicing stress reduction techniques to relax muscle tension in the jaw can help alleviate some of the pain and swelling associated with TMJD.
-Use corrective oral appliances: Oral appliances may help reduce tension on the jaw muscles and the joint. Permanent changes in the bite through extensive crown or bridge work and orthodontics have not been proven to be effective and may worsen TMJD symptoms. If a contributing factor is teeth grinding or clenching, a splint or night guard can be worn while sleeping. Clenching and grinding cannot be stopped but the oral appliance will help prevent tooth-to-tooth wear. The goal is that TMJD symptoms will be reduced as the affected area experiences a period of reduced irritation and use.
Sometimes the severity of the TMJD condition is such that more invasive treatment options are required. However, special care must be taken before deciding to undergo any invasive solution. Surgical treatments are often irreversible and remain controversial, as they have not been proven effective by any studies or research. If surgery is being considered when all other treatment options have fallen short of providing satisfactory relief, there are three only a few types of surgery that may be considered:
- Arthrocentesis: This procedure is the least invasive of any procedure. It involves injecting steroids into the joint to reduce inflammation.
- Arthroscopy: This procedure is guided by a very small camera inserted through a small incision in front of the ear. The camera allows the doctor to examine the temporomandibular joint and establish a cause of the TMJ condition, such as tissue inflammation or a misaligned disc or joint. Then the oral surgeon can correct the problem by removing inflamed tissue or adjusting alignment of the joint.
- Open-joint surgery: If arthroscopic surgery is not available for any number of reasons, the TMJ region may need to be opened to allow an oral surgeon full view and access to the temporomandibular joint for diagnosis and correction.
Other less traditional approaches to TMJD have been applied, including ultrasound, radio-wave therapy, transcutaneous electrical nerve stimulation (TENS) and trigger-point injections in the case of TMJD caused by a myofascial condition.